Overview and Indications
Using innovative technology, a minimally invasive surgery (MIS) spinal fusion can be accomplished using two small poke-hole incisions with minimal tissue dissection resulting in a faster recovery. Using the MIS procedure, posterior lumbar fusions (PLF) and transforaminal lumbar interbody fusions (TLIF) can both be performed in less time, with less tissue damage and less pain than traditional open spinal fusion surgery.
Posterior Lumbar Fusion (PLF) is the general term used to describe the technique of surgically mending two or more lumbar spine bones together along the sides of the bone. Bone graft is placed along side the spine bones (not in between the disc spaces as in an interbody fusion), and ultimately fused together. Minimally invasive PLF is generally always performed in conjunction with the use of metal screws and rods so as to impart immediate stability while the bone mends and to increase the fusion rate. MIS TLIF includes the PLF described above, as well as performing an interbody fusion, which means the intervertebral disc is removed and replaced with a bone spacer. A MIS TLIF involves placing only one bone graft spacer in the middle of the interbody space without retraction of the spinal nerves.
The MIS PLF technique is often favored as the 2nd staged procedure when a multiple level Anterior Lumbar Interbody Fusion is performed, and a laminectomy is not necessary. A MIS TLIF is commonly performed when one or two spinal levels are being fused in conjunction with a partial posterior decompression (facetectomy and laminectomy), and interbody fusion is indicated.
MIS PLF and MIS TLIF are commonly performed for a variety of spinal conditions, such as spondylolisthesis and degenerative disc disease, among others.
Most patients are usually able to go home one to three days after surgery. Patients will typically stay longer, approximately two to five days, if an anterior spinal surgery is also performed. Before patients go home, physical therapists and occupational therapists work with patients and instruct them on proper techniques of getting in and out of bed and walking independently. Patients are instructed to avoid bending at the waist, lifting more than five pounds, and twisting in the early postoperative period (first two to four weeks) to avoid a strain injury. Patients can gradually begin to bend, twist and lift after four to six weeks as the pain subsides and the back muscles get stronger.
Patients are generally not required to wear a back brace after surgery. Some patients may be issued a soft or rigid lumbar corset that can provide additional lumbar support in the postoperative period, if necessary.